Chapter 5: Ethical and Professional  Criteria for impropriety in multiple

Issues in Clinical Psychology relationships: impairment in the

psychologist and exploitation or
American Psychological Association Code harm to the client
of Ethics
Competence
 First published in 1953, with nine
subsequent revisions  Competence includes being a
 Applies to all specialties, but competent psychologist, boundaries
especially relevant to clinical of competence, and remaining
psychologists competent
 Divided into aspirational (general  Personal problems and burnout can
principles) and enforceable (ethical affect competence
standards)
 Models for ethical decision making, Ethics in Clinical Assessment
such as Celia Fisher's model
 Psychologists' ethical beliefs based  Ethical considerations in test
on surveys and studies selection, test security, and test data

Confidentiality Ethics in Clinical Research

 Confidentiality specifically  Ethical obligations in conducting

mentioned in general principles and research
ethical standards  Efficacy of psychotherapy and the
 Tarasoff case and the duty to warn ethical dilemma of participants who
and protect don't receive treatment
 Challenges faced by clinical
psychologists in interpreting and Contemporary Ethical Issues
applying duty to warn
 Dilemmas when the client is a child  Managed care and the position of
or adolescent and how much to divided loyalty
reveal to parents  Ethical issues related to technology,
such as psychological tests on the
Informed Consent internet and online therapy practices
 Ethics in small communities and
 Informed consent is required during ways to overcome ethical issues
research, assessment, and therapy
 Facilitates an educated decision- Chapter 6: Conducting Research in
making process Clinical Psychology

Boundaries and Multiple Relationships Why Do Clinical Psychologists Do

Research?
 Multiple relationships can be
problematic  To gain knowledge about
 Ethical standard 3.05a defines sexual psychological disorders and establish
and nonsexual multiple relationships a foundation for the field
How Do Clinical Psychologists Do Page 35: The Experimental Method
Research?
 The development of hypotheses in
 Research on treatment outcomes to the experimental method includes
determine the effectiveness of independent and dependent
therapies variables.
 Distinguishing between statistical  Randomized clinical trials (RCTs)
significance and clinical significance are used to maximize internal
 Research on assessment methods to validity.
evaluate and improve them  RCTs are criticized for producing
 Research on diagnostic issues, such results that may not translate to the
as validity, reliability, and real world.
relationships between disorders
 Research on professional issues, Page 36: Quasi-Experiments
including activities, beliefs, and
practices  Quasi-experimental designs are used
 Research on teaching and training when constraints limit the testing of
issues, such as training philosophies certain hypotheses.
and specialized training  Quasi-experimental designs are less
scientifically sound than
Conclusion experimental designs.

 Clinical psychologists engage in Page 37: Between-Group Versus Within-

research to gain knowledge about Group Designs
psychological disorders, evaluate
treatment outcomes, improve  Between-group designs involve an
assessment methods, explore experimental group and a control
diagnostic issues, examine group.
professional issues, and address  Within-group designs involve
teaching and training concerns. comparisons of participants in a
Ethical considerations, such as single condition at various points in
confidentiality, informed consent, time.
boundaries, and competence, are
essential throughout the research Page 38: Analogue Designs
process.
 Analogue designs involve an
Page 34: How Do Clinical Psychologists approximation of the target client or
Do Research? situation.
 Analogue designs use participants
 The experimental method is used in whose characteristics resemble those
clinical psychology research. of the target population, or ask
 The method involves observation of participants to imagine themselves in
events, development of hypotheses, a certain situation.
empirical testing of the hypotheses,
and alteration of hypotheses based on Page 39: Correlational Methods
results.
  Correlational studies are conducted conclusions and offering
when neither an experiment nor a suggestions.
quasi-experiment is plausible.
 Correlational studies examine the Page 44: Cross-Sectional Versus
relationship between two or more Longitudinal Designs
variables.
 Cross-sectional designs are easier
Page 40: Case Studies and more efficient.
 Longitudinal designs require longer
 Case studies involve a thorough, periods of time and provide valid
detailed observation and examination approximations for changes that take
of a person or situation and place or evolve over time.
individual behavior.
 Case studies stimulate systematic Page 45: Use of Technology in Clinical
research which converges on Psychology Research
important findings.
 Technology is used for data
Page 41: Case Studies collection in clinical psychology
research, such as sending e-mail
 Case studies are highly regarded by surveys and using actigraphs to
researchers who prefer an measure sleep quality.
idiographic approach.  Amazon Mechanical Turk or Mturk
 Case studies use some variation of an is also used for data collection.
ABAB design.  Technology is also used as a clinical
intervention.
Page 42: Meta-Analysis
Page 46: Chapter 7 Diagnosis and
 Meta-analysis is a statistical method Classification Issues
of combining results of separate
studies to create a summation of Page 47: Defining Normality and
findings. Abnormality
 Meta-analysis is a quantitative
analysis in which the full results of  Abnormality can be defined by
previous studies each represent a personal distress to the individual,
small part of a larger pool of data. deviance from cultural norms,
statistical infrequency, and impaired
Page 43: Meta-Analysis social functioning.

 The process of conducting a meta- Page 48: Defining Normality and

analysis should incorporate five Abnormality
steps: formulating the research
question, obtaining a representative  The harmful dysfunction theory
study sample, obtaining information defines a disorder as a harmful
from individual studies, conducting dysfunction, combining value and
appropriate analyses, and reaching scientific components based on
social norms.
  Harmful dysfunction refers to the  Discussions of abnormal behavior
failure of a mental mechanism to appear in ancient Chinese, Hebrew,
perform a natural function. Egyptian, Greek, and Roman texts.
 Hippocrates' theories of abnormality
Page 49: Who Defines Abnormality? emphasized natural causes and were
a significant early step to current
 The Diagnostic and Statistical definitions.
Manual of Mental Disorders (DSM)
defines mental disorder as a Page 54: Diagnosis and Classification of
clinically significant disturbance in Mental Disorders: A Brief History
cognition, emotion regulation, and
behavior.  Mental asylums were established in
 The DSM indicates a dysfunction in Europe and the U.S. in the 19th
mental functioning and distinguishes century, helping to categorize
it from expectable reactions to disorders.
common stressors.  There was an evolution of common
terminology in the field of mental
Page 50: Who Defines Abnormality? disorders.

 The DSM reflects a medical model Page 55: Diagnosis and Classification of
of psychopathology and is influenced Mental Disorders: A Brief History
by the culture and values of those
defining disorders.  Emil Kraepelin is considered the
 The DSM categorizes disorders with founding father of the current
a list of specific symptoms. diagnostic system.
 Kraepelin labeled specific categories,
Page 51: Importance for Professionals such as manic-depressive psychosis
and dementia praecox.
 The presence or absence of a
diagnostic label strongly impacts the Page 56: Diagnosis and Classification of
attention it receives from clinical Mental Disorders: A Brief History
psychologists.
 In the late 1800s and early 1900s, the
Page 52: Importance for Clients collection of statistical and census
data was the primary purpose of
 The absence of a diagnosis means diagnostic categories.
the absence of a label.  The Veterans Affairs developed its
 The label of a diagnosis can lead to own early categorization system to
stereotyping of individuals and can facilitate diagnosis and treatment of
have an effect on the outcome of soldiers returning from World War
legal issues. II, which had a significant influence
on the creation of the first DSM.
Page 53: Diagnosis and Classification of
Mental Disorders: A Brief History Page 57: DSM—Earlier Editions (I and
II)
  DSM-I was published by the APA in  Included many new disorders
1952.  DSM-III-R, DSM-IV, and DSM-IV-
 A revision was published as DSM-II TR retained major changes
in 1968. introduced by DSM-III and
 Both editions were similar to each introduced significant other changes
other but different from subsequent
DSM editions. DSM-5: The Current Edition

Page 58: DSM—Earlier Editions (I and  Published in 2013, the first

II) substantial revision after 20 years
 Led by David Kupfer and Darrel
 DSM-I and DSM-II defined only Regier
three categories: psychoses,  Researched over 12 years
neuroses, and character disorders.  Coordinated efforts with WHO
 The definitions of disorders in these  Steps included the creation of Task
editions were not scientifically or Force, work groups, scientific review
empirically based. committee, field trials, and a website
to communicate progress to the
Diagnosis and Classification of Mental public
Disorders: A Brief History
DSM-5: The Current Edition—Changes
DSM—Earlier Editions (I and II) DSM-5 Did Not Make

 Language reflected psychoanalytic  Changes considered but not made

approach to understanding people include the use of biological markers
and their problems as diagnostic tools, rating of
 Vague descriptions of clinical disorders/symptoms on a scale, and a
conditions described in prose dimensional approach toward a
 Specific symptoms or criteria not disorder
listed  Rejections of new disorders such as
 Very limited generalizability or attenuated psychosis syndrome,
utility for clinicians mixed anxiety-depressive disorder,
and internet gaming disorder
DSM—More Recent Editions (III, III-R,
IV, and IV-TR) DSM-5: The Current Edition—New
Features in DSM-5
 DSM-III (1980) relied on empirical
data and used specific diagnostic  Title change to DSM-5
criteria to define disorders  Dropped multiaxial assessment
 Psychoanalytic language replaced by system
terminology that reflected no single
school of thought DSM-5: The Current Edition—New
 Multiaxial assessment system Disorders in DSM-5
introduced
 Longer and more expansive than  Premenstrual dysphoric disorder
predecessors
  Disruptive mood dysregulation normal people, promote diagnostic
disorder inflation, and encourage
 Binge eating disorder inappropriate medication use
 Mild neurocognitive disorder (mild  Specific criticisms by others include
NCD) diagnostic overexpansion,
 Somatic symptom disorder (SSD) transparency of the revision process,
 Hoarding disorder membership of the work groups,
field trial problems, and price
DSM-5: The Current Edition—Revised
Disorders in DSM-5 Criticisms of the DSM

 Bereavement exclusion  Recent editions of DSM widely used

 Autism spectrum disorder by all mental health professions
 Attention-deficit/hyperactivity  Strengths include emphasis on
disorder: increased age of symptoms empirical research, use of explicit
from 7 to 12, minimum number of diagnostic criteria, interclinician
symptoms in adults increased to 5 reliability, atheoretical language, and
 Bulimia nervosa: frequency of binge facilitated communication between
eating reduced to once/week researchers and clinicians
 Anorexia nervosa: reduction of less  Criticisms include breadth of
than 85% of the body weight coverage, controversial cutoffs,
 Substance use disorder cultural issues, gender bias,
 Mental retardation renamed nonempirical influences, and
intellectual disability or intellectual limitations on objectivity
development disorder
 Learning disabilities in math, Page 83: Alternative Directions in
reading, and writing combined as Diagnosis and Classification
specific learning disorder
 Obsessive Compulsion Disorder  Categorical Approach
removed from Anxiety Disorders to  Dimensional Approach
new category o Five-factor model of
 Mood Disorders split into two: personality
Depressive Disorders and Bipolar  Neuroticism
and related disorders  Extraversion
 Openness to
DSM-5: The Current Edition— experience
Controversy Surrounding DSM-5  Agreeableness
 Conscientiousness
 Many "work group" members quit
midway Page 85: The Interviewer (1 of 7) General
 Leaders of mental health Skills
organizations boycotted DSM-5
 Allen Frances was the most vocal  Interviewer should acquire general
critic, criticizing changes as unsafe skills as foundation for conducting
and scientifically unsound, and interviews
arguing that DSM-5 will mislabel  Requirements
 o Quieting themselves o Shifting topics smoothly
o Being self-aware
o Developing positive working Page 90: The Interviewer (6 of 7) Specific
relationships with clients Behaviors: Referring to the Client by the
Proper Name
Page 86: The Interviewer (2 of 7) Specific
Behaviors: Eye Contact  Inappropriate addressing can
jeopardize the client's sense of
 Eye contact comfort with interviewer
o Facilitates and communicates  Mistakes
listening o Using nicknames or
o Makes client feel heard shortening names
o Requires interviewer to have o Omitting essential "middle"
cultural knowledge and name
sensitivity o Addressing client by first
name
Page 87: The Interviewer (3 of 7) Specific
Behaviors: Body Language Page 91: The Interviewer (7 of 7) Specific
Behaviors: Observing Client Behaviors
 Culture shapes connotations of body
language  Important decisions can be informed
 General rules for interviewer by behavioral observations of client
o Face the client  Observing behaviors allows
o Appear attentive psychologist to consider nonverbal
o Minimize restlessness components
o Display appropriate facial
expressions Page 92: Components of the Interview (1
of 13) Rapport
Page 88: The Interviewer (4 of 7) Specific
Behaviors: Vocal Qualities  Strong sense of rapport brings sense
of connect with interviewer
 Skilled interviewers  To establish good rapport with
 Use pitch, tone, volume, and clients
fluctuation o Make an effort to put the
 Attend closely to the vocal qualities client at ease
of clients o Acknowledge unique,
unusual situation of clinical
Page 89: The Interviewer (5 of 7) Specific interview
Behaviors: Verbal Tracking o Enhance rapport by following
client's lead
 Effective interviewers monitor the
client's train of thought by Page 93: Technique: Directive Versus
o Repeating key words and Nondirective Styles
phrases
o Weaving clients' language  Directive questioning approach
into their own
 o Tends to be targeted toward  May consist of specific diagnosis
specific pieces of information  May involve recommendations
o Client responses are typically
brief Page 105: Pragmatics of the Interview (1
o Can sacrifice rapport in favor of 4) Note Taking
of informational data that
clients may not otherwise  Documents the interview
choose to disclose  More reliable than interviewer's
 Nondirective questioning approach memory
o Client may choose to spend  Could be a distraction to client
time on some topics  Distracts from noticing important
o Can provide crucial client behaviors
information that interviewers  Effect of taking notes highly
may not otherwise know to dependent on situation
inquire about
o Can fall short in terms of Page 106: Pragmatics of the Interview (2
gathering specific of 4) Audio and Video Recordings
information
 Best strategy involves balance and  Recording interview requires client's
versatility written permission
o Using only a directive  Could hinder openness and
approach could sacrifice willingness to disclose information
rapport in favor of  Client appreciates explanation of
information rationale for recording
o Using only a nondirective
approach can facilitate Page 107: Pragmatics of the Interview (3
rapport but fall short of of 4) The Interview Room
gathering specific
information  Types
o Traditional, psychoanalytic
Page 96: Technique: Specific Interviewer arrangement
Responses o Interviewer and client sitting
face-to-face
 Open- and closed-ended questions o Interviewer and client in
 Clarification chairs at an angle between
 Confrontation 90° and 180°
 Paraphrasing  Setting should facilitate fundamental
 Reflection of feeling goals of interview
 Summarizing  Should steer clear of overtly personal
items
Page 104: Conclusions
Page 108: Pragmatics of the Interview (4
 Depends on interview type, setting, of 4) Confidentiality
client's problem, etc.
 Provides initial conceptualization of  Many assume that sessions are
client's problem absolutely confidential
  Some situations require psychologist  However, they have disadvantages
to break confidentiality such as inhibiting rapport and the
 Some assume that related others have client's opportunity to elaborate or
access to interview records hence, explain, not allowing for inquiries
disclose very little not related to DSM diagnostic
 Interviewers should explain policies categories, and requiring a more
regarding confidentiality comprehensive list of questions.
 In unstructured interviews,
Types of Interviews interviewers improvise and
determine questions on the spot to
 The form of an interview depends on seek relevant information.
the setting, client's presenting  The SCID is an example of a
problem, and the issues the interview structured interview that asks about
is intended to address. specific symptoms of disorders listed
 There are several types of interviews, in the DSM.
including intake interviews,
diagnostic interviews, mental status Mental Status Exam
exams, and crisis interviews.
 The mental status exam is most often
Intake Interviews employed in medical settings and is
intended for brief, flexible
 Intake interviews are used to administration requiring no manual
determine whether a client needs or other materials.
treatment and what form of treatment  It captures the psychological and
is needed. cognitive processes of an individual
 These interviews involve detailed "right now."
questioning about the client's  The exam lacks standardization, with
presenting complaint. different questions within the same
category.
Diagnostic Interviews  Some main categories include
appearance, behavior, mood, speech,
 Diagnostic interviews are used to orientation, and memory.
assign DSM diagnoses to a client's
problems. Crisis Interviews
 They include questions that relate to
the criteria of DSM disorders.  Crisis interviews assess problems
demanding urgent attention, such as
Structured Interviews vs. Unstructured suicide, and provide immediate and
Interviews effective intervention.
 Key components of crisis interviews
 Structured interviews have include quickly establishing rapport
advantages such as producing a and expressing empathy.
diagnosis based explicitly on DSM
criteria, being empirically sound, and Cultural Components
being standardized.
  Interviewers should be culturally Wechsler intelligence tests and other
competent and appreciate the cultural related tests.
context.
 There is variability among Neuropsychological Tests
individuals within cultural groups.
 Consideration of religion as a  Neuropsychological tests, such as the
component of culture is important. Halstead-Reitan Neuropsychological
Test Battery and the Bender Visual-
Acknowledging Cultural Differences Motor Gestalt Test, are used to
assess cognitive functioning.
 Open, respectful discussion of
cultural variables can enhance Intelligence Testing
rapport and increase the client's
willingness to share information. Wechsler Intelligence Tests
 Interview questions can be used to
inquire about the cultural  Cover entire life span
backgrounds of clients.  Vary as per demands of measuring
intelligence at different ages
Intelligence Testing  Separate tests, not variants of one
another
 There is no consensus regarding the  Single full-scale intelligence score,
definition of intelligence. four and five index score, and
 Classic theories of intelligence specific subtest scores
include Charles Spearman's theory of  Administered one-on-one and face-
a singular intelligence and Louis to-face
Thurstone's theory of many  Brief subtest with items of increasing
intelligences. difficulty levels
 More contemporary theories of  Core or supplemental subtests
intelligence include James Cattell's  Five categories of subtests of WISC
theory of fluid and crystallized and WPPSI
intelligence and John Carroll's Three o Share three with WAIS
Stratum Theory of Intelligence. o Perceptual Reasoning Index
has
Wechsler Intelligence Tests  Visual Spatial Index
 Fluid Reasoning
 The Wechsler intelligence tests, Index
including the WAIS-IV, WISC-V,  Four categories of subtests of WAIS
and WPPSI-IV, are widely used. o Verbal Comprehension Index
 These tests assess intelligence in o Perceptual Reasoning Index
different age ranges. o Working Memory Index
o Processing Speed Index
At-a-Glance Information About the Tests  Large sets of normative data
 Scores reflect IQ
 The table provides information about  Backed by impressive psychometric
the most recent editions, year data
published, and age ranges for the
  Used for wide range of clinical  Appropriate only for young clients
applications  Limited psychometric data
 Limited connection between tests
and day-to-day life Achievement Testing
 Complex or subjective scoring on
some subtests Achievement Versus Intelligence

Stanford-Binet Intelligence Scales—Fifth  Intelligence—cognitive capacity

Edition  Achievement—person’s
accomplishments
 Similar to Wechsler tests  Comparison of intelligence and
 Administered face-to-face and one- achievement key factor in
on-one determining learning disabilities
 Employs hierarchical model of  Terminology changed in DSM-5
intelligence  Achievement Tests
 Yields singular measure of full-scale o KeyMath achievement test
IQ, five factor scores, many specific o Gray Oral Reading
subtest scores achievement test
 Features same means and standard o Woodcock Tests of
deviations Achievement (WJ-ACH)
 Psychometric data similarly strong o Kaufman Test of Educational
 Covers entire life span as a single Achievement (KTEA)
test o Wechsler Individual
 Includes normative data for specific Achievement Test (WIAT)
relevant diagnoses  Wechsler Individual Achievement
 Features exactly five factors Test—Third Edition
measured both verbally and o For ages 4 to 50 years
nonverbally o Administered face-to-face
and one-on-one
Additional Tests of Intelligence: o Measures achievements in
Addressing Cultural Fairness four broad areas
 Reading
 Universal Nonverbal Intelligence  Math
Test-2 (UNIT-2)  Oral language
o Language free test  Written language
o Administered one-on-one and  Yields standard scores on same scale
face-to-face as intelligence tests
o No verbal instructions  Linked to Wechsler IQ tests
o Instructions via eight specific  Strong reliability and validity data
hand gestures supports WIAT-III
o Appropriate for clients aged 5
to 21 years Neuropsychological Testing
o Six subtests: Two tiers
 Memory Specialized area of assessment within
 Reasoning clinical psychology
 Assesses limited range of abilities
  Measures cognitive functioning or  Luria-Nebraska Neuropsychological
impairment of the brain Battery (LNNB)
 Fixed-battery phase to flexible- o Wide-ranging test of
battery phase neuropsychological
 Full Neuropsychological Batteries functioning like HRB
o Halstead-Reitan o Consists of 12 scales
Neuropsychological Battery o Emphasis on qualitative data
(HRB) in addition to quantitative
o Luria-Nebraska data
Neuropsychological Battery
(LNNB) Full Neuropsychological Batteries (Page
o NEPSY-II 156)
o Bender Visual-Motor Gestalt
Test—Second Edition  NEPSY-II
(Bender-Gestalt-II) o Designed specifically for
o Rey-Osterrieth Complex children between 3 and 16
Figure Test years
o Repeatable Battery for the o Based on the general
Assessment of principles of Luria-Nebraska
Neuropsychological Status test
(RBANS) o Includes 32 separate subtests
o Wechsler Memory Scale— across 6 different categories
Fourth Edition (WMS-IV)
Brief Neuropsychological Measures (Page
Full Neuropsychological Batteries (Page 157)
154)
 Bender Visual-Motor Gestalt Test—
 Halstead-Reitan Neuropsychological Second Edition (Bender-Gestalt-II)
Battery (HRB) o Most commonly used test
o Battery of eight standardized o Straightforward copying task
neuropsychological tests o Measures visuoconstructive
o Suitable for ages 15 years and abilities
above o Takes only 6 minutes to
o Alternate versions available administer
for younger clients
o Administered only as a whole Brief Neuropsychological Measures (Page
battery 158)
o Primary purpose to identify
people with brain damage  Rey-Osterrieth Complex Figure Test
o Helps in diagnosis and o Brief pencil-and-paper
treatment of problems related drawing task comprising
to brain malfunction single complex figure
o Involves use of colored
Full Neuropsychological Batteries (Page pencils at various points in
155) test
 o Examiner can trace client’s
sequential approach to
complex copying task
o Includes a memory
component

Brief Neuropsychological Measures (Page

159)

 Repeatable Battery for the

Assessment of Neuropsychological
Status (RBANS)
o Focuses on a broader range of
abilities than Bender-Gestalt
or Rey-Osterrieth
o Measures verbal skills,
attention, and visual memory
o Takes 20 to 30 minutes to
complete
o Includes 12 subtests in 5
categories

Brief Neuropsychological Measures (Page

160)

 Wechsler Memory Scale—Fourth

Edition (WMS-IV)
o Often used to assess
individuals between 16 and
90 years with suspected
memory problems
o Assesses
 Visual and auditory
memory across seven
subtests
 Immediate and
delayed recall